Targeting inefficiency

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 - Evan headshot 2013
Evan Godt, Editorial Director

Inefficiency is kryptonite to healthcare. In an era where providers are being asked to do more with less, wasteful workflows and inefficient resource usage sap the ability to offer the highest levels of patient care.

Knowing this, when a provider spots an inefficiency, it’s important to understand how to further optimize workflow. One recent example in the literature comes from researchers at Emory University in Atlanta, who discovered many ED patients may be needlessly undergoing dual-modality chest imaging.

Published in the Journal of the American College of Radiology by Tarek Hanna, MD, and colleagues from Emory, the study looked at more than 3,600 consecutive ED patients who received both chest x-ray and chest CT in a single ED visit from January 2009 to December 2013.

Hanna and colleagues found many cases where the extra imaging likely offered no clinical value, only increased costs and radiation doses to patients.

Some instances of definitive waste included cases in which the chest x-ray was performed after the completion of the chest CT and the results of the CT scan were already uploaded into PACS. Thankfully, this was less than 1 percent of all dual-imaged patients in the study.

Other potentially wasteful scenarios were more common, however. In 2.5 percent of cases, both exams were ordered at the same time, and while there are certain scenarios where this makes sense—ED physicians may order both simultaneously hoping for faster x-ray results to rule out certain conditions while waiting on the chest CT, for example—in none of these cases in the study did x-ray results alter clinical care.

Those cases may be outliers, but another source of possible inefficiency noted by the authors is any case when the second imaging order is placed before the report from the first order is available. This happened in 50.3 percent of cases, and CT was the first modality ordered in just 1.2 percent of cases.

“Ultimately, better electronic medical records and computerized physician order entry system processes, including automated warnings of existing orders for same-body-part imaging, could be harnessed to reduce use of redundant examinations,” Hanna and colleagues wrote.

The report serves as a reminder on the importance of workflows. All radiology departments should be looking to increase the value they provide, and targeted technology solutions for workflows offer a way to reach this goal.